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Cholecystectomy

Introduction

The gallbladder is an organ in the right upper part of the abdomen that works alongside the liver to aid with digestion. It concentrates bile from the liver. Sometimes the bile then develops small salts, which often accumulate to form stones, which can become quite large. These stones can cause pain (biliary colic) and this is the most common reason to need the gallbladder removed.

Other reasons include severe pain (cholecystitis), pain from the gallbladder without stones (acalculous cholecystitis), polyps and rarely cancer.

Once the gallbladder becomes diseased there is really no option other than to remove it (if the patient is fit for surgery), as the symptoms are very likely to recur. Each time the gallbladder gets inflamed it can make it harder to remove and therefore potentially more dangerous.

If a gallbladder has stones but has caused no medical problems or symptoms then the gallbladder does not need to be removed. Sometimes the stones in the gallbladder escape via the cystic duct and cause problems such as jaundice or pancreatitis.

Laparoscopic Cholecystectomy Procedure

The liver secretes a fluid called bile, which travels down the bile duct to the duodenum to help digest fat in particular. The bile gets otherwise stored and concentrated in the gall bladder until it is required. Cholecystectomy involves disconnecting the gall bladder at the cystic duct and peeling it from the liver and surrounding structures.

 

Symptoms

The symptoms from a diseased gall bladder include pain, nausea, loss of appetite and features of infection such as fever and feeling unwell. Jaundice ("going yellow") and itch can occur when there are stones in the bile duct or when the gallbladder is severely inflamed.

The pain is classically "colicky" meaning it comes and goes or pulsates, usually occurs in the upper right side of the abdomen or upper abdomen and can radiate around to the back. It typically occurs after a fatty meal but can occur any time. If it lasts only a few minutes to hours it is called biliary colic, but if it lasts longer than this it might represent an infection or severe inflammation of the gallbladder, which is called cholecystitis. In cholecystitis the pain is more severe and constant and can last for several hours or days.

 

Management

Pain relief (codeine), avoiding fats and medical attention are required. Contact your surgeon or attend the nearest emergency department of a hospital for severe symptoms. Ultrasound and blood tests are the basic tests required for most cases. It is possible that stones may have escaped from the gallbladder and these need to be looked for and removed. Finding the stones may involve CT (Computer Tomography) or MRCP (Magnetic Resonance Cholngio-Pancreat-ography) or intraoperative imaging (IOC). If errant stones are found they might be removed surgically or involve a further procedure called ERCP (Endoscopic Retrograde Cholangio-Pancreatography).

The surgery might need to be done when the symptoms occur (emergency surgery) or delayed until the inflammation has settled down (elective surgery).

 

The Operation

Four small (5 to 15mm) incisions are made in the wall of the abdomen and instruments introduced through them. The inside of the abdomen can then be visualised and the gallbladder detached and removed by drawing it out through the incision in the umbilicus. Sometimes it is not possible to perform the operation this way (eg because of difficulty seeing clearly) and then the operation is completed through a large incision ("Open Cholecystectomy"). The operation usually lasts about half an hour.

Single Incision Laparoscopic (SIL) Cholecystectomy is a new procedure where a single, slightly larger incision is made in the umbilicus.  It is sometimes also called “no-scar surgery”, referring to the fact that there are no scars being visible outside the umbilicus after surgery. It has the potential advantages of better cosmesis and less pain.

X-ray of organs during a laprasopic cholecystectomy. The picture shows the the liver on top, the gall tree on top of the liver, the cystic duct going from the gall bladder to the common bile duct going down to duodenum.

 X-ray of organs during a laparoscopic cholecystectomy. The picture shows the the liver on top, the gall tree on top of the liver, the cystic duct going from the gall bladder to the common bile duct going down to duodenum.

 

Operative Risks

For any operation there are risks, and in particular there is a risk of infection, bleeding and injury.

The overall risk of major complications is 2%. The specific risks in laparoscopic cholecystectomy are bleeding (1 in 200), liver injury (1 in 200), leaking or injured cystic duct or bile leak (1 in 100), bowel injury (1 in 1000) and bile duct injury (1 in 1000). Surgery is required generally to repair these, and sometimes extensive surgery.

The risks of the surgery are greater depending to a large degree on how damaged the gallbladder is and how stuck it is to adjacent structures. The risks are generally higher in emergency surgery. The most common outcome is no complications or a minor problem that will pass such as wound infection (5%). Conversion to open surgery is required in around 2%. All figures are approximate.

Mr Draper has performed over 1500 Laparoscopic Cholecystectomies and the current complication rate is less than 0.2%.

Cholecystectomy - Gall Bladder Surgery 

 

Post Operative Recovery

Most people are ready to go home 1 or 2 days post surgery and need 2 weeks convalescence before returning to work. Postoperative problems such as pain, shoulder tip pain and nausea are usually easily managed. It may be surprising that it is very rare that removing the gallbladder (which is important in the digestion of fat) results in any noticeable dietary changes.

 

More Information

This brief information sheet is best considered a reference to be used in conjunction with discussions with your surgeon. For further information discuss your operation in detail with your surgeon, or refer to our Information Sheets.

 

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